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How does Dental Disease affect my Pet?

Over 70% of cats and 80% of dogs who are 3 years of age or older suffer from significant dental disease.  Dental disease is characterised by the presence of plaque, calculus and gum infection, otherwise known as gingivitis. 

Plaque is a sticky, colorless biofilm of bacteria, sugars and protein that adheres to the teeth.  If plaque is not removed (e.g. by brushing teeth) it mineralises to form tartar (calculus) which is the visible yellow/brown accumulation on teeth. 

 

The bacteria in plaque/tartar then spread underneath the gumline and cause periodontal disease –this is destruction of the structures supporting the teeth -(bones, gums and ligaments) -causing pain, inflammation and eventually infection.  This is painful and irreversible changes occur if dental disease is not identified and treated early enough.

 

Dental disease is graded based on severity from 1-4 and without further preventative care, plaque will begin to reform on the tooth surface within 24 hours of a professional teeth clean (scale and polish).  It is for this reason that we recommend ongoing preventative dental care, with which we are happy to assist, and for which our dental program is designed.  Joining the dental program is free of charge.

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Top 5 Symptoms of Dental Disease

  1. Smelly breath (halitosis)

    • While there are many causes of bad breath, dental disease is by far the most common

    • The smell may start quite subtly, but worsens over time

  2. Reluctance to eat hard food/biscuits, or dropping food​

    • Animals are experts at hiding pain and will often simply stop doing things that cause pain.  The most common symptom of dental pain is for animals to stop eating hard food, or to drop it after picking it up

  3. Facial swelling over the cheek

    • Tooth root abscesses often occur on the large molars which can cause a firm, painful swelling underneath the eye

  4. Drooling or red, painful gums

    • Gum infections and dental disease are painful, causing red gums and occasionally drooling

  5. Weight loss

    • As above, animals stop doing things that cause pain, including eating if a particular tooth (or multiple teeth) are very painful.  This decrease in eating can be one cause of weight loss in our pets

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Diagnosis and Management

An initial assessment of your pet's dental status can be made in consultation during a physical examination.

Since so much dental disease is present under the gum line (and is therefore not visible on simple examination) we can often only truly diagnose the full extent of the problem after your pet is anaesthetized. 

 

Once they are asleep, the process is very similar to how your own dentist examines your teeth.  Your vet will scale and polish the plaque/calculus from the surface of the teeth, and ideally, a COHAT (Comprehensive Oral Health and Assessment) should then be performed. 

The COHAT, put simply, is where your vet:

  • assesses the hard and soft tissue structures in the mouth

  • probes the gums around each tooth to assess for any loss of attachment

  • inspects each tooth for chips, fractures or enamel damage

  • x-rays the teeth to fully assess any disease that may be occurring under the gum line

  • and the teeth are scaled and polished above and below the gum line

 

Your pet is then woken up and the vet will thoroughly review the radiographs to review for abnormalities such as tooth root abscess, tooth fractures, bone loss, developmental abnormalities and missing teeth.  The information gathered from the x-ray review then allows a full treatment plan to be formed, which can then be performed under a second anaesthetic approximately 2-3 weeks later.  Splitting the procedure into two shorter anaesthetics (rather than one longer one) allows us to minimize the amount of time that your pet is under each anaesthetic which decreases the risks.

Should you prefer, a dental scale and polish can be performed on its own, but the absence of performing a COHAT severely limits the information upon which the treatment plan is based, and is therefore likely to mean that some disease processes are more likely to be missed. 

Rest assured, your pet's best interests are always at the foremost of any decisions that we make, so should there be any concerns about your pet undergoing two anaesthetics, for example elderly pets or pets with multiple health conditions, this will be fully evaluated and discussed with you prior to going ahead with any dental procedure.

While there is an inherently small risk with any sedation (as with people), modern anaesthetics are very safe, and our experienced staff are highly skilled at monitoring anaesthetics under a wide range of health circumstances.  For most animals, two shorter anaesthetics are safer than one long anaesthetic, hence our recommendation that the COHAT procedure should ideally be done separate to the procedure in which any extractions are performed. 

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TPLO Surgery & Post Op Care

Preparing Your Home

Prior to your pet’s surgery, speak to us about how to best confine your dog during their recovery. Making your dog as comfortable as possible is just as important as a good rehabilitation plan.

Since your dog’s mobility will be restricted following an extensive orthopaedic surgery such as the TPLO, we recommend taking the following steps:

  • If your dog is crate trained, find a crate that’s large enough for him/her to stand up in & turn around.

  • Create a gated off area in your home, such as the kitchen or living room to restrict them to certain areas.

  • Rooms with hardwood floors, tile, or linoleum can be particularly difficult for dogs to walk on, especially after surgery. If the room you’ve chosen has slippery surfaces like these, be sure to place some throw rugs with rubber backing on the floor to help your dog walk around more easily during the post-op period

At Vogue Vets & Wellness Centre, we use several different methods and modalities for pain management.

Anesthesia protocols commonly include the following:

  • Injectable analgesics and anti-inflammatories – Given before, during, and after surgery as needed to stay ahead of the pain. These are used either as intermittent injections or constant rate infusions.

  • Cold Compression Therapy – Provides post-operative control of swelling and pain with the use of cold and compression.

  • Post-operative oral pain medication combinations to be sent home for the first 1-2 weeks after surgery

 

We also offer post operative rehabilitation which includes pain relieving modalities such as laser therapy, pulsed magnetic field therapy, therapeutic exercises and hydrotherapy to assist your pet in recovering as quickly as possible.  Rehab can be commenced as early as the day following surgery, whilst hydrotherapy cannot be safely instigated until 4-6 weeks post op

Will my Pet Experience any Pain?

What is the Success Rate of TPLO Surgery?

The success rate of TPLO surgery is extremely high, with as many as 90-95% of dogs returning to near-normal function. Compared to any other procedure, dogs who undergo TPLO surgery recover more quickly and get back on all four feet sooner. With TPLO surgery and proper rehabilitation, your dog will most likely be able to recover completely from a CCL tear and regain full mobility. The vast majority of patients return to normal or nearly-normal activity within six months.

In comparison, dogs with extracapsular repairs are often walking much sooner after surgery, but tend to plateau after 6 months and often only reach 80% normal capacity post operatively.

It is also important to understand that a high percentage of dogs who develop cruciate disease in one leg will go on to rupture the cruciate in the second leg, within 12 months.  Statistically, 85% of dogs with no surgical intervention will go on to rupture the second leg within 3 years, compared with 25% of dogs who have early surgical intervention.  Whilst rehab cannot guarantee that the second leg won't rupture, post operative rehab does significantly reduce the odds of the second cruciate being torn.

What are the Possible Complications of TPLO Surgery?

It is very important to note that whilst every attempt is made to treat or repair cruciate injury, none of the above treatments or surgery will bring the knee joint back to 100%. Thus, over time, the onset of arthritis in the joint is inevitable. How rapidly this sets in and advances is variable, however, in most cases, a surgical approach to treatment, lessens this onset but does not negate it all together.

 

Before making any decision to proceed with surgery in any pet, it is important that you, the pet owner, are aware of the possible complications of surgery in these cases. Whilst complications are rare, they do happen and in some cases, may result in subsequent surgery being needed.

 

These possible complications can be:

  • Infection

    • Whilst every effort is made to prevent this from occurring (sterile operating environment, intravenous antibiotics and dispensed antibiotics), sometimes infections do occur and can be difficult to clear. Most infections occur from self-trauma (licking at wounds etc) and environmental contamination (dirt on wound or swimming too soon etc). It is thus very important that an Elizabethan collar is kept on your pet and that you keep your pet indoors during the initial recovery stage. 

  • Non-union of the bone (TPLO)

    • This refers specifically to the surgeries involving surgical cutting of the tibia and using plates and screws. It is very rare but can occur when bone healing just does not progress as expected in individual cases.

  • Meniscus damage

    • As mentioned previously, this is something that can be evident at the time of surgery, but can also occur weeks to months after surgery. It is the most common cause of lameness in patients after surgery (in 5-8% of TPLO cases post surgery). Further surgery is required in these cases to remove the torn cartilage otherwise pain and thus non-use muscle atrophy in the leg occurs.

  • Nerve damage

    • This is an extremely rare complication of surgery, but can occur when healing and inflammation of the tissues surrounding the knee joint impact on the nerves in the area. Scuffing of the toe nails when walking is the most common sign of this. This is most often seen with the extracapsular repair surgery.

  • Hardware (i.e. plates and screws or monofilament suture) loosening and/ or failure

    • Very rarely do we see loosening of the screws in the plate, but this can occur, especially if too much activity occurs in the beginning. Breakage of the plate can also occur as well as rupture/ snapping of the monofilament loop. Further surgery is then required in these cases.

  • Fracture of the Tibia (Shin Bone) – (TPLO)

    • This can occur especially if any jumping/ running happens too soon after surgery. It can occur just under the last screw through the bone. Another surgery will then be required to place a plate and screws on the back end of the tibia to stabilise the fracture

  • Anaesthetic complications

    • Whilst every endeavour is made to limit these (pre-anaesthetic checks and blood tests, fluids, advanced monitoring, up to date anaesthetic protocols), we do see many variable complications arising from anaesthesia similar to those experienced in the human surgical field.

  • Bandaging Complications

    • We do see dermatitis reactions to bandaging material or dressings applied fairly commonly. Sometimes your pet’s bandage/ dressing will need to be removed earlier and sometimes we will still replace the bandage/ dressing if these are not too severe. These often resolve quickly after bandage/ dressing removal and may require some skin ointments to be applied

  • Seroma/ fluid accumulation

    • Pockets of fluid can accumulate after any surgery. This is due to movement of tissues against one another or leakage of fluid from the joint. We will normally drain this fluid off and check for infection. Repeated drainage and bandaging with strict rest is sometimes required to resolve these.

  •  Post-operative swelling/ bruising

    • This is very common and expected in most cases of TPLO surgeries. Most commonly any swelling occurs around and just above the hock (ankle) area. Ice packs can be applied as well as massage to help with this. It generally resolves within 3-5 days.

Whilst, as mentioned, complications are rare, the above are the most commonly seen or experienced.  It is important to note that whilst some of these only require medical treatment, some may necessitate further surgery.

 

Please feel free to discuss any concerns or questions you may have with one of our veterinarians at any time.

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After Your Surgery: What Happens Next?

We feel it is important to remain available for your questions and concerns before and after surgery. Routine rechecks following TPLO are therefore scheduled at 24 hours, 2 weeks postoperatively, and with recheck radiographs (x-rays) obtained at the 8-week point.  Additional rechecks may be scheduled as needed.

Recovery & Rehabilitation

Following a TPLO surgery your dog’s activity level must be restricted to short leash walks only (preventing running/jumping activities) for a full 10-12 weeks.

This means no jumping on or off the bed, on/off the couch, or on people. We recommend starting with very short walks to urinate/defecate only and then gradually increase the duration of those walks through the rehabilitation period.

Access to stairs should be limited as much as possible, especially for the first 2-4 weeks after surgery. Help guide your pet up and downstairs with a short leash, harness, or sling. If you have stairs in your home, limit your dog’s access with a baby gate to prevent unsupervised use.

When your pet is alone, he/she should be restricted to a small area or a crate. Adequately restricting your pet’s activity level plays a major role in successful outcomes post-surgery.

We recommend refraining from active play until your veterinarian or rehab therapist tells you otherwise (likely until after the 8-week post-op radiographs to confirm bone healing).

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